Breast Cancer May Return Even 20 Years Later, Study Finds

Breast cancer may return even 20 years later except if patients keep taking drugs to suppress it, researchers reported Wednesday.

They were looking for proof that at least some of the breast cancer survivors might be capable to skip the pills that decrease the risk of the breast tumors coming back but established that even women that have “low-risk” cancers had a tiny rate of reappearance 15 and even 20 years later.

This means that women with the most widespread type of breast cancer, called estrogen-positive or hormone-positive breast cancer must think cautiously about whether they want to stop taking the pills, even if they can cause some side-effects, doctors said.

“These breast cancers have a lasting smoldering quality and bear a substantial risk of late recurrence after five years of therapy,” said Dr. Harold Burstein of the Dana Farber Cancer Institute, who wasn’t involved in the study.

“A lot of patients think. ‘OK, I made it to five years. I know I’m safe’,” said Dr. Jennifer Litton, an oncologist at the MD Anderson Cancer Center. “But for estrogen-receptor positive breast cancer, it’s a constant lifelong risk.”

Breast cancer is the second-biggest cancer killer of American women, just after lung cancer. The American Cancer Society says every year; it’s diagnosed in 200,000 women and a few men and kills around 40,000.

Most types of breast cancers are fueled by estrogen, and drugs called hormone blockers are recognized to cut the risk of reappearance in such cases.

Tamoxifen long was the number one choice, but newer drugs called aromatase inhibitors — sold as Arimidex, Femara, Aromasin and in generic form — do the same job with less risk of causing uterine cancer and additional problems Longer the women is taking them, the lower their risk of having cancer come back.

Nonetheless, they do cause side-effects.

“My colleagues and I state that at the end of 5 years, the women separate themselves into two groups: those who cannot wait to get off it, and those who are frightened of getting off it and have tolerated it well,” said Dr. Eric Winer of the Dana-Farber Cancer Institute.

Melita Keith, 45, from Victoria, Texas speaks that she has been putting up with pains and aches after taking first tamoxifen and then Aromasin.

“I’ve been having pretty harsh joint pains, hot flashes, etc. In the morning, when I get out of bed I feel like I’m 90. My joints hurt,” said Keith, who was diagnosed with breast cancer when she was just 41. “On tamoxifen, I got hot flashes and pretty strong night sweats. On a scale of one to 10, I was 7.”

Breast Cancer May Return Even 20 Years Later, Study Finds

Keith, a patient of Litton’s, required to stop. “But if Dr. Litton tells me I must be on it, I’m staying on it. I have to be here for my kids,” added Keith, who has a daughter in 6th grade and a son in 12th grade.

Litton and Keith plan to work together to watch symptoms over the years and make a decision how long Keith will continue taking the pills.

“The idea of being considered cured if you are cancer-free for 5 years isn’t true for estrogen-positive breast cancer, even though it is true for triple-negative.”

Doctors have recognized that breast cancer can come back in a fraction of survivors. Hongchao Pan of the University of Oxford, Dr. Daniel Hayes of the University of Michigan Comprehensive Cancer Center and colleagues researched medical records of more than 80,000 women with certain types of breast cancer who were planned to take tamoxifen or similar drugs for at least five years.

“Even after 5 years women with ER-positive, early-stage breast cancer still had a constant risk of reappearance and death from breast cancer for at least 20 years after the first diagnosis,” they wrote in their report, available in the New England Journal of Medicine.

“Although these women stayed free of reappearance in the first five years, the risk of having their cancer come back elsewhere (for example in the bone, liver or lung) from years five to 20 remained constant,” Hayes said.

“I do not wish women to hear this study and think they are destined for their cancer to come back,” said Litton.

Winer said breast cancer survivors must keep an eye on their symptoms.

“If a woman develops ill-defined symptoms at year 12, and she’s being taken care of by someone not familiar with breast cancer it may take six months to get to the bottom of it,” he said.